Patient positioning support structure

ABSTRACT

A patient support system includes independently adjustable end columns supporting a centrally hinged, jointed or breaking patient support structure. At least one column includes a powered rotation assembly. The patient support includes at least two sections. A coordinated drive system provides for both upwardly and downwardly breaking or jointed orientations of the two sections in various inclined and tilted positions. Cable, cantilevered and pull-rod systems are included.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Ser. No. 13/317,012, filedOct. 6, 2011, now U.S. Pat. No. 8,719,979, which is a continuation ofU.S. Ser. No. 12/460,702, filed Jul. 23, 2009, now U.S. Pat. No.8,060,960, which is a continuation of U.S. Ser. No. 11/788,513, filedApr. 20, 2007, now U.S. Pat. No. 7,565,708, which claimed the benefit ofU.S. Provisional Application No. 60/798,288 filed May 5, 2006 and wasalso a continuation-in-part of U.S. patent application Ser. No.11/159,494 filed Jun. 23, 2005, now U.S. Pat. No. 7,343,635, that is acontinuation-in-part of U.S. patent application Ser. No. 11/062,775filed Feb. 22, 2005, now U.S. Pat. No. 7,152,261, all of which areincorporated by reference herein.

BACKGROUND OF THE INVENTION

The present invention is directed to structure for use in maintaining apatient in a desired position during examination and treatment,including medical procedures such as imaging and surgery and inparticular to such a structure that allows a surgeon to selectivelyposition the patient for convenient access to the surgery site andproviding for manipulation of the patient during surgery including thetilting, pivoting, angulating or bending of a trunk and/or a joint of apatient in a supine, prone or lateral position.

Current surgical practice incorporates imaging techniques andtechnologies throughout the course of patient examination, diagnosis andtreatment. For example, minimally invasive surgical techniques, such aspercutaneous insertion of spinal implants, involve small incisions thatare guided by continuous or repeated intra-operative imaging. Theseimages can be processed using computer software programs that producethree dimensional images for reference by the surgeon during the courseof the procedure. If the patient support surface is not radiolucent orcompatible with the imaging technologies, it may be necessary tointerrupt the surgery periodically in order to remove the patient to aseparate surface for imaging followed by transfer back to the operatingsupport surface for resumption of the surgical procedure. Such patienttransfers for imaging purposes may be avoided by employing radiolucentand other imaging compatible systems. The patient support system shouldalso be constructed to permit unobstructed movement of the imagingequipment and other surgical equipment around, over and under thepatient throughout the course of the surgical procedure withoutcontamination of the sterile field.

It is also necessary that the patient support system be constructed toprovide optimum access to the surgical field by the surgery team. Someprocedures require positioning of portions of the patient's body indifferent ways at different times during the procedure. Some procedures,for example, spinal surgery, involve access through more than onesurgical site or field. Since all of these fields may not be in the sameplane or anatomical location, the patient support surfaces should beadjustable and capable of providing support in different planes fordifferent parts of the patient's body as well as different positions oralignments for a given part of the body. Preferably, the support surfaceshould be adjustable to provide support in separate planes and indifferent alignments for the head and upper trunk portion of thepatient's body, the lower trunk and pelvic portion of the body as wellas each of the limbs independently.

Certain types of surgery, such as orthopedic surgery, may require thatthe patient or a part of the patient be repositioned during theprocedure while in some cases maintaining the sterile field. Wheresurgery is directed toward motion preservation procedures, such as byinstallation of artificial joints, spinal ligaments and total discprostheses, for example, the surgeon must be able to manipulate certainjoints while supporting selected portions of the patient's body duringsurgery in order to facilitate the procedure. It is also desirable to beable to test the range of motion of the surgically repaired orstabilized joint and to observe the gliding movement of thereconstructed articulating prosthetic surfaces or the tension andflexibility of artificial ligaments, spacers and other types of dynamicstabilizers before the wound is closed. Such manipulation can be used,for example, to verify the correct positioning and function of animplanted prosthetic disc, spinal dynamic longitudinal connectingmember, interspinous spacer or joint replacement during a surgicalprocedure. Where manipulation discloses binding, sub-optimal position oreven crushing of the adjacent vertebrae, for example, as may occur withosteoporosis, the prosthesis can be removed and the adjacent vertebraefused while the patient remains anesthetized. Injury which mightotherwise have resulted from a “trial” use of the implantpost-operatively will be avoided, along with the need for a second roundof anesthesia and surgery to remove the implant or prosthesis andperform the revision, fusion or corrective surgery.

There is also a need for a patient support surface that can be rotated,articulated and angulated so that the patient can be moved from a proneto a supine position or from a prone to a 90° position and wherebyintra-operative extension and flexion of at least a portion of thespinal column can be achieved. The patient support surface must also becapable of easy, selective adjustment without necessitating removal ofthe patient or causing substantial interruption of the procedure.

For certain types of surgical procedures, for example spinal surgeries,it may be desirable to position the patient for sequential anterior andposterior procedures. The patient support surface should also be capableof rotation about an axis in order to provide correct positioning of thepatient and optimum accessibility for the surgeon as well as imagingequipment during such sequential procedures.

Orthopedic procedures may also require the use of traction equipmentsuch as cables, tongs, pulleys and weights. The patient support systemmust include structure for anchoring such equipment and it must provideadequate support to withstand unequal forces generated by tractionagainst such equipment.

Articulated robotic arms are increasingly employed to perform surgicaltechniques. These units are generally designed to move short distancesand to perform very precise work. Reliance on the patient supportstructure to perform any necessary gross movement of the patient can bebeneficial, especially if the movements are synchronized or coordinated.Such units require a surgical support surface capable of smoothlyperforming the multi-directional movements which would otherwise beperformed by trained medical personnel. There is thus a need in thisapplication as well for integration between the robotics technology andthe patient positioning technology.

While conventional operating tables generally include structure thatpermits tilting or rotation of a patient support surface about alongitudinal axis, previous surgical support devices have attempted toaddress the need for access by providing a cantilevered patient supportsurface on one end. Such designs typically employ either a massive baseto counterbalance the extended support member or a large overhead framestructure to provide support from above. The enlarged base membersassociated with such cantilever designs are problematic in that they canand do obstruct the movement of C-arm and O-arm mobile fluoroscopicimaging devices and other equipment. Surgical tables with overhead framestructures are bulky and may require the use of dedicated operatingrooms, since in some cases they cannot be moved easily out of the way.Neither of these designs is easily portable or storable.

Thus, there remains a need for a patient support system that provideseasy access for personnel and equipment, that can be easily and quicklypositioned and repositioned in multiple planes without the use ofmassive counterbalancing support structure, and that does not requireuse of a dedicated operating room.

SUMMARY OF THE INVENTION

The present invention is directed to a patient support system thatpermits adjustable positioning, repositioning and selectively lockablesupport of a patient's head and upper body, lower body and limbs in upto a plurality of individual planes while permitting tilting, rotation,angulation or bending and other manipulations as well as full and freeaccess to the patient by medical personnel and equipment. The system ofthe invention may be cantilevered or non-cantilevered and includes atleast one support end or column that is height adjustable. Theillustrated embodiments include a pair of opposed independentlyheight-adjustable end support columns. The columns may be independent orconnected to a horizontally length-adjustable base. One support columnaccording to the invention may be coupled with a wall mount or otherstationary support. A patient support structure is connected to andbridges substantially between the pair of end supports. For example, inan embodiment according to the invention, the patient support structureis hingedly suspended between the end supports.

The patient support structure may be a frame or other patient supportthat is semi-constrained, having at least first and second hingeable orotherwise joined or connected portions, the first and second portionsbeing selectively lockable in a first substantially planar orientationalong a longitudinal axis of the support structure that resemblesconventional constrained or fixed patient support structures. However,the hinged or semi-constrained support structure of the inventionprovides for the first and second portions that are also positionableand lockable in a plurality of angles with respect to one another, witheach portion being movable to a position on either side of the firstplanar orientation. In other words, the patient support structure iscapable of hinging or otherwise bending to form an angulation, break orjoint, either upwardly or downwardly from a horizontal starting positionand also when the support structure is in an inclined or declinedposition due to one of the support columns raising one end of thestructure higher than another end. Furthermore, in addition to an “up”or “down” break, such a break or joint created by the two portions maybe oriented from side-to-side, as when the support structure is rotatedabout a longitudinal axis thereof.

In a particular illustrated embodiment, articulation, jointing orbreaking of the patient support structure at a central location betweenthe pair of stationary end supports is supported by a cable drive system(tension band suspension). In another embodiment, a pull-rod assemblysupports articulation to control the break or articulation angle andrender the patient support structure rigid. Such an embodiment furtherincludes a substantially fixed slider bar disposed at an end of thepatient support, the patient support structure being supported by andslidingly movable along such slider bar with the bar following the angleof inclination of the patient support at such end. Other embodimentsinclude cantilevered systems with connected or unconnected movable ortelescoping base supports. The first and second patient supportstructure portions may be in the form of frames, such as rectangularframes or other support structure that may be equipped with support padsfor holding the patient, or other structure, such as imaging tops whichprovide a flat surface.

The patient support structure and the support column or columns arecoupled with respective rotation, articulation or angulation adjustmentstructure for positioning the first support portion with respect to afirst column or end support and with respect to the second supportportion and the second support portion with respect to the second columnor end support. Rotation adjustment structure in cooperation withpivoting and height adjustment structure provide for the lockablepositioning of the first and second patient support portions at avariety of selected positions and articulations with respect to thesupport columns including angulation coupled with Trendelenburg andreverse Trendelenburg configurations as well as providing for patientroll over in horizontal or tilted orientation. Lateral movement (towardand away from a surgeon) may also be provided by a bearing blockfeature. A pair of patient support structures (such as a support frameand an imaging table) may be mounted between end supports of theinvention and then rotated in unison about a longitudinal axis toachieve 180° repositioning of a patient, from a prone to a supineposition.

In another embodiment, an apparatus for supporting a patient during amedical procedure is provided, the apparatus including a base structurewith first and second spaced opposed end supports; each end supportbeing attached to the base structure; an elongate patient supportstructure including first and second portions joined inwardly at anarticulation, the patient support structure outwardly connected to theend supports and being alignable in a first plane and movable to aplurality of angular orientations with respect to one another on eitherside of the first plane; the inward articulation joining the first andsecond portions and movable to a plurality of angular orientationsassociated with the angular orientations of the outwardly connected endsof the patient support structure relative to the end supports; atranslation connector subassembly cooperating with the inwardarticulation and outwardly connected ends of the patient supportstructure so as to allow the patient support structure to move throughthe various angular orientations thereof without the spaced opposed endsupports moving relative to each other with respect to a spaced opposeddistance; and a structure to move the articulation into the variousangular orientations.

In a further embodiment, at least one of the end supports includes afirst vertical height adjustor and a second vertical height adjustor ispositioned between the spaced opposed end supports.

In a further embodiment, the translation connector subassembly furtherincludes at least one slider bar, slidably attached to one of the firstand second portions, the slider bar pivotally attached to one of the endsupports.

In a further embodiment, at least one of the end supports furtherincludes a rotation mechanism.

In a further embodiment, the patient support structure is detachable andplacable at either end in a plurality of locations vertically spacedfrom a floor.

In a further embodiment, the articulation has a hinge mechanism thatcooperates with the various angular orientations.

Yet another embodiment provides an apparatus for supporting a patientduring a medical procedure, including a support subassembly includingfirst and second spaced opposed upright end supports; each end supportbeing attached to a respective base structure; at least one of the firstand second end supports being vertically height adjustable; an elongatepatient support with first and second ends and extending between thefirst and second end supports; the patient support being held by the endsupports in spaced relation with respect to a floor, the patient supportconnected to and supported between the end supports; the patient supporthaving a single breaking location spaced from the end supports andadapted to interact with the patient when the patient is located on thepatient support; and a vertical elevator connecting a patient supportfirst end with a respective end support; the vertical elevator beingcontrollable to allow continuous non-segmented adjustment of the supportfirst end relative to the respective end support so as to align andorient the patient support subassembly; and wherein the patient supportis controllable to be upwardly and downwardly articulatable at both thefirst and second ends of the patient support relative to respective endsupports and at the breaking location so as to be adapted to manipulatea patient into a plurality of selectively prone and non-prone positionsin cooperation with an end support translation compensation mechanism,while also cooperating with the end supports to move the patient betweenvertical positions.

Still another embodiment provides an apparatus for supporting a patientduring a medical procedure, the apparatus including a supportsubassembly including first and second spaced opposed upright endsupports; each end support being attached to a respective basestructure; at least one of the first and second end supports beingvertically height adjustable; an elongate patient support with first andsecond ends and extending between the first and second end supports; thepatient support being held by the end supports in spaced relation withrespect to a floor, the patient support connected to and supportedbetween the end supports; the patient support having a single breakinglocation spaced from the end supports and adapted to interact with thepatient when the patient is located on the patient support; and avertical elevator connecting a patient support first end with arespective end support; the vertical elevator being controllable toallow continuous non-segmented adjustment of the support first endrelative to the respective end support so as to align and orient thepatient support subassembly; and wherein the patient support iscontrollable to be upwardly and downwardly articulatable at both thefirst and second ends of the patient support relative to respective endsupports and at the breaking location so as to be adapted to manipulatea patient into a plurality of selectively prone and non-prone positionsin cooperation with a patient support translation compensationmechanism, while also cooperating with the end supports to move thepatient between vertical positions.

Objects and Advantages of the Invention

Therefore, it is an object of the present invention to overcome one ormore of the problems with patient support systems described above.Further objects of the present invention include providing breaking orhinged patient support structures; providing such structures whereinsuch break or joint may be in any desired direction; providing suchstructures that include at least one base support structure that allowsfor vertical height adjustment; providing such a structure wherein suchbase support is located at an end of the patient support, allowing forpatient positioning and clearance for access to the patient in a widevariety of orientations; providing such a structure that may be rotatedabout an axis as well as moved upwardly or downwardly at either endthereof; and providing apparatus and methods that are easy to use andespecially adapted for the intended use thereof and wherein theapparatus are comparatively inexpensive to make and suitable for use.

Other objects and advantages of this invention will become apparent fromthe following description taken in conjunction with the accompanyingdrawings wherein are set forth, by way of illustration and example,certain embodiments of this invention.

The drawings constitute a part of this specification and includeexemplary embodiments of the present invention and illustrate variousobjects and features thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a patient support structure according tothe invention.

FIG. 2 is an enlarged and partial side elevational view of a portion ofthe support structure of FIG. 1.

FIG. 3 is an enlarged and partial top plan view of the support structureof FIG. 1.

FIG. 4 is an enlarged and partial perspective view of a portion of thestructure of FIG. 1.

FIG. 5 is an enlarged and partial side elevational view of a portion ofthe structure of FIG. 1.

FIG. 6 is an enlarged and partial perspective view of a portion of thestructure of FIG. 1.

FIG. 7 is an enlarged and partial perspective view of a first hinge ofthe structure of FIG. 1.

FIG. 8 is an enlarged and partial perspective view of a cooperatingsecond hinge of the structure of FIG. 1.

FIG. 9 is an enlarged and partial elevational view of the hinge of FIG.7.

FIG. 10 is an enlarged and partial perspective view of an outer portionof the hinge of FIG. 7 with portions broken away to show the detailthereof.

FIG. 11 is an enlarged and partial perspective view of an inner portionof the hinge of FIG. 7 with portions broken away to show the detailthereof.

FIG. 12 is an enlarged and partial perspective view of a portion of thestructure of FIG. 1 showing a cable drive motor and winch cylinders.

FIG. 13 is a partial perspective view of a patient support frame of thestructure of FIG. 1.

FIG. 14 is a partial perspective view of a patient imaging top forreplacement with the patent support frame of FIG. 13.

FIG. 15 is a reduced perspective view of the structure of FIG. 1 shownwith an imaging top of FIG. 14 replacing the support frame of FIG. 13and shown in a planar inclined position.

FIG. 16 is a perspective view of the structure of FIG. 15 shown in aplanar tilted position.

FIG. 17 is a perspective view of the structure of FIG. 15 shown in aplanar inclined and tilted position.

FIG. 18 is a side elevational view of the structure of FIG. 15 shown ina symmetrical upward breaking position.

FIG. 19 is a side elevational view of the structure of FIG. 15 shown ina first inclined and upward breaking position.

FIG. 20 is a side elevational view of the structure of FIG. 15 shown ina second inclined and upward breaking position.

FIG. 21 is a side elevational view of the structure of FIG. 15 shown ina symmetrical downward breaking position.

FIG. 22 is a side elevational view of the structure of FIG. 15 shown ina first inclined and downward breaking position.

FIG. 23 is a side elevational view of the structure of FIG. 15 shown ina second inclined and downward breaking position.

FIG. 24 is an enlarged side elevational view of the structure of FIG. 1shown in an upward breaking, inclined and tilted position.

FIG. 25 is a is a perspective view of a second embodiment of a patientsupport structure according to the invention including a patient supportframe and an imaging table shown in a first spaced orientation.

FIG. 26 is a perspective view of the patient support structure of FIG.25 shown tilted in an intermediate position during a rotation as wouldbe used for a patient rollover.

FIG. 27 is a perspective view of the structure of FIG. 25 shown furthertilted in a second intermediate position during rotation.

FIG. 28 is a perspective view of the structure of FIG. 25 shown afterrotation to a final flipped position.

FIG. 29 is a perspective view similar to FIG. 25 showing the patientsupport frame and the imaging table in a second spaced orientation.

FIG. 30 is a front elevational view of a third embodiment of a patientsupport structure according to the invention.

FIG. 31 is a front elevational view of a fourth embodiment of a patientsupport structure according to the invention.

FIG. 32 is a perspective view of a fifth embodiment of a patient supportstructure according to the invention shown in a planar inclinedposition.

FIG. 33 is a perspective view of the structure of FIG. 32 shown in aninclined and upward breaking position.

FIG. 34 is a perspective view of the structure of FIG. 32 shown in asubstantially symmetrical downward breaking position.

FIG. 35 is a reduced side elevational view of a sixth embodiment of apatient support structure according to the invention shown in asubstantially horizontal and planar position.

FIG. 36 is a reduced side elevational view of the structure of FIG. 35shown in a symmetrical downward breaking position.

FIG. 37 is a reduced side elevational view of the structure of FIG. 35shown in a symmetrical downward breaking position.

FIG. 38 is an enlarged and partial top plan view of a portion of thestructure of FIG. 35 and shown in the same position as shown in FIG. 35.

FIG. 39 is an enlarged and partial side elevational view of thestructure of FIG. 35 and shown in the same position as shown in FIG. 35.

FIG. 40 is an enlarged and partial side elevational view of thestructure of FIG. 35 and shown in the same position as shown in FIG. 35.

FIG. 41 is an enlarged and partial perspective view of the structureshown in FIG. 40.

FIG. 42 is an enlarged and partial top plan view of a portion of thestructure of FIG. 35 and shown in the same position as shown in FIG. 36.

FIG. 43 is an enlarged and partial side elevational view of thestructure of FIG. 35 and shown in the same position as shown in FIG. 36.

FIG. 44 is an enlarged and partial side elevational view of thestructure of FIG. 35 and shown in the same position as shown in FIG. 36.

FIG. 45 is an enlarged and partial top plan view of a portion of thestructure of FIG. 35 and shown in the same position as shown in FIG. 37.

FIG. 46 is an enlarged and partial side elevational view of thestructure of FIG. 35 and shown in the same position as shown in FIG. 37.

FIG. 47 is an enlarged and partial side elevational view of thestructure of FIG. 35 and shown in the same position as shown in FIG. 37.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

As required, detailed embodiments of the present invention are disclosedherein; however, it is to be understood that the disclosed embodimentsare merely exemplary of the invention, which may be embodied in variousforms. Therefore, specific structural and functional details disclosedherein are not to be interpreted as limiting, but merely as a basis forthe claims and as a representative basis for teaching one skilled in theart to variously employ the present invention in virtually anyappropriately detailed structure.

Referring now to the drawings, a patient positioning support structureaccording to the invention is generally designated by the referencenumeral 1 and is depicted in FIGS. 1-12. The structure 1 includes firstand second upright support piers or columns 3 and 4 which areillustrated as independent, stationary floor base support structures asshown in FIG. 1 or may be connected to one another by a non-telescopingbase support as illustrated in the embodiment shown in FIGS. 25-28. Insome embodiments according to the invention as shown, for example, inFIGS. 32-34, the base connection places the columns in a selectivelytelescoping relationship. It is also foreseen that in certainembodiments according to the invention, one of the support columns maybe replaced by a conventional operating room table, or may even be awall mount. In the first illustrated embodiment, the upright supportcolumn 3 is connected to a first support assembly, generally 5, and theupright support column 4 is connected to a second support assembly,generally 6. Between them, the support assemblies 5 and 6 uphold aremovable elongate, articulate jointed or breaking patient holding orsupport structure, generally 10 and optionally, a second removablepatient support structure that will be described with respect to anotherembodiment of the invention. The illustrated support structure 10includes a first frame section 12, a second frame section 14 with atransverse support cross bar 15, and a pivot or hinge assembly,generally 16. In the illustrated embodiment, the pivot assembly furtherincludes a cable drive system including a dual winch 18 and cooperatingcables 20.

The columns 3 and 4 are supported by outwardly extending feet 22 thatmay or may not include spaced apart casters or wheels (not shown) eachequipped with a floor-lock foot lever for lowering the feet 12 into afloor-engaging position as shown in FIG. 1. The columns 3 and 4 eachinclude two or more telescoping lift arm segments 3 a, 3 b and 4 a, 4 b,respectively that permit the height of each of the columns 3 and 4 to beselectively increased and decreased in order to raise and lower all or aselected portion of the connected patient support structure 10. It isforeseen that the vertical supports 3 and 4 may be constructed so thatthe column 3 has a greater mass than the support column 4 or vice versain order to accommodate an uneven weight distribution of the human body.Such reduction in size at the foot end of the system 1 may be employedin some embodiments to facilitate the approach of personnel andequipment.

Each of the support assemblies 5 and 6 generally includes a rotationsubassembly 26 and 26′ and an angulation subassembly 27 and 27′,respectively, that are interconnected as will be described in greaterdetail below and include associated power source and circuitry linked toa controller 29 (FIG. 1) for cooperative and integrated actuation andoperation. The rotational subassemblies 26 and 26′ enable coordinatedrotation of the patient support structure 10 about a longitudinal axisof the structure 1. The angulation subassemblies 27 and 27′ shown inFIGS. 2 and 3 enable the selective hinging, articulation or breaking ofthe support 10 at the hinge assembly 16 at desired levels and incrementsas well as selective tilting of the frame portions 12,14 with respect toa longitudinal axis of such frame portion.

The rotation subassembly or mechanism 26, shown in FIGS. 1 and 5,includes at least one motor housing 30 surmounting the support column 3.In the illustrated embodiment, only one rotational motor is provided,but it is foreseen that a cooperating motor may also be mounted on thesupport column 4. A main rotational shaft 32 extends from the motorhousing 30 that turns a rotation structure 33. The rotation structure 33in turn rotates the connected patient support 10 about a longitudinalaxis as will be described in greater detail below. The motor housing 30contains a rotary electric motor or other actuator drivingly engagedwith the shaft 32. The rotation mechanism 26 is operated by actuatingthe motor using a switch or other similar means. The rotation structure33 is fixed to the shaft 32 at a location spaced from the motor housing30 and the support column 3 to provide clearance for rotation of theconnected patient support structure 10.

As shown in FIGS. 4 and 5, the rotation structure 33 is attached to apair of translation posts or H-bar posts 40 disposed at either end ofthe rotation structure 33. The posts 40 are each attached to thestructure 33 by a pin 42, bolt, or other fixing structure. A pluralityof cooperating apertures 44 formed in the posts 40 provide passagewayfor a pivot pin 46 to extend therethrough. The pivot pin 46 isreceivable in each cooperating pair of apertures 44 allowing forselective placement of a translation connector 48 that is sized andshaped to be received between the pair of posts 40 and also receive thepivot pin 46 therethrough. The pin 46 and connector 48 are thuspositionable in an orientation transverse to the longitudinal extensionof the support 10 at a variety of heights to be selected by the surgeonand readily changeable, even during surgery if necessary, to vary theheight of the frame section 12. The multiple location or height featureis also advantageous when more than one frame or patent structure ismounted in tandem as shown, for example in FIGS. 25-29. The position ofthe frame or other structure may be desirably changed to provide closeproximity to an imaging top with a distance between a patient supportand an imaging top being expandable or reduceable depending upon thesize or other attributes of a patient and surgical or otherrequirements. As illustrated in FIG. 5, the connector 48 has a slot 50for receiving the pivot pin 46.

Also with reference to FIGS. 4 and 5, the translation connector 48 is inturn attached to a pivot connector 52. The pivot connector 52 includesfirst and second outwardly opening and opposed slots 54 and 56. Thefirst slot 54 is sized and shaped for receiving the translationconnector 48 and the second slot is sized and shaped for receiving anend connection 58 of the frame section 12. The pivot connector 52further includes a through aperture or bore 60 running substantiallyperpendicular to the slot 54 and communicating therewith. The aperture60 is sized and shaped to receive a pivot pin 62 therethrough. Theconnector 48 also includes a through bore 60′ that receives the pivotpin 62. The swivelable connection provided by the pin 62 allows for someforward and rearward lateral movement of the attached frame endconnection 58 and thus the frame section 12, providing a degree offreedom and clearance needed for rotation the patient support about alongitudinal axis of a patient. The slot 56 is sized and shaped tofrictionally engage the frame end connection 58, thus securely fixingthe end connection 58 to the pivot connector 52. The frame endconnection 58 is in turn fixed to each of elongate frame members 66 and68 of the frame section 12. The frame members 66 and 68 are eachhingedly connected to the hinge assembly 16 to be described in greaterdetail below. Pivoting of the translation connector 48 with respect tothe pin 46 provides for selected articulation of the frame section 12(that includes the end connection 58 and the frame members 66 and 68)and/or the entire support 10 with respect to the support pier or column3.

With reference to FIG. 6, at the support pier or column 4, the supportassembly 6 is substantially similar to the support assembly 5 with theexception that the rotation subassembly 26′ can be passive and,therefore, not include a motor. However, the support pier or column 4preferably includes a powered mechanism to provide selective heightadjustment of the subassembly 26′. A rotation structure 33′ is spacedfrom and freely rotatable with respect to the column 4. The structure33′ includes a shaft (not shown) extending outwardly therefrom similarto the rotation shaft 32, the shaft being rotatingly received in anaperture in the support column 4.

The rotation subassembly 26′ and the angulation subassembly 27′otherwise include elements identical to or substantially similar to theelements of the subassemblies 26 and 27. Specifically, H-bar posts 40′,pin 42′, apertures 44′, pivot pin 46′, translation connector 48′, slot50′, pivot connector 52′, end connector 58′ and pivot pin 62′, areidentical or substantially similar in form and cooperate with otherelements identically or substantially similarly to what has beendescribed previously herein with respective H-bar posts 40, pin 42,apertures 44, pivot pin 46, translation connector 48, slot 50, pivotconnector 52, end connector 58 and pivot pin 62.

The frame 14 further includes frame members 66′ and 68′ that are eachfixed to the end connector 58′. The frame members 66′ and 68′ arepivotally or hingedly connected to respective frame members 66 and 68 bythe hinge assembly 16. Specifically, the frame member 66 is attached tothe frame member 66′ by the hinge mechanism 70 and the frame member 68is attached to the frame member 68′ by the hinge mechanism 72.

With particular reference to FIGS. 3, 7 and 9-11, the hinge mechanism 70includes an outer member 76 and an inner member 78. The outer member 76is fixed or may be integral with the elongate frame member 66, while theinner member 78 is integral or otherwise fixed to the frame member 66′.The outer member 76 further includes an extension 80 with a groove 82for receiving and guiding the cable 20. The extension 80 tapers in adirection from the outer member interior 84 to the groove 82. Theextension 80 is configured to cause a slight upward break or bend of thesupport 10 when the extension 80 comes into contact with the cable 20 atthe groove 82. In that way, when the cables 20 are reeled in to shortenthe hypotenuse of the triangle formed by the cable, the section 12 andthe section 14, the sections 12 and 14 move toward one another,resulting in the upward break as illustrated, for example, in FIG. 18.The downward break or joint illustrated, for example, in FIG. 21 is aresult of lengthening the cable 20 distance and allowing gravity to dropthe hinge 70. The extension 80 is shaped to extend slightly inwardlytoward a longitudinal axis A of the support 10, thereby guiding thecable 20 along a path within a periphery of the frame sections 12 and 14when the extension 80 is in contact with the cable 20 when in a downwardbreaking configuration directed toward the cable with the cable 20 beingreceived at the groove 82.

It is foreseen that if an exclusively upward breaking or jointingembodiment is desired according to the invention, the sections 12 and 14may be positioned with respect to two end columns to always include aslight upward break, joint or bend at the hinge or pivot between thesections 12 and 14. When the telescoping base is actuated to move thecolumns toward one another, the sections 12 and 14 would automaticallyfurther break or articulate upwardly and toward one another. Downwardbreaking or jointing would not be possible in such an embodiment as themaximum distance between the two end columns would still ensure a slightupward break or hinge between the sections 12 and 14. Such an embodimentwould be acceptable for use because patient holding pads could bepositioned on the frames 12 and 14 such that the patient would be in asubstantially horizontal position even when there is a slight upwardbend or break at the hinge between the sections 12 and 14.

Returning to the hinge 70 of illustrated embodiment, the inner member 78is slidingly and rotatably receivable in an interior 84 of the outermember 76. The outer member has a pair of pivot apertures 86 and theinner member has a pivot aperture 87, the apertures cooperating tocreate a through bore for receiving a pivot pin 88 through both theinner and outer hinge members. The interior 84 includes a curvedpartially cylindrical surface 89 for slidingly receiving a cooperatingouter rounded and partially cylindrical surface 90 of the inner member78. The inner member 78 further includes a downward breaking stop orprojection 92 that limits a downward pivot (in a direction toward thecables 20) of the hinge 70 in the event the cables 20 should fail. Thestop 92 abuts against a surface 93 of the interior 84. In theillustrated embodiment, the stop 92 limits the extent of rotation orhinging of the section 66 with respect to the section 66′ to abouttwenty-five degrees. Upward pivot (in a direction away from the cables20) is limited by abutment of an inner planar surface 95 with a planarsurface 96 of the hinge inner member 78.

With particular reference to FIG. 8, the hinge mechanism 72 issubstantially a mirror image of the hinge mechanism 70 and thereforeincludes the following elements: a hinge outer member 76′, an innermember 78′, an extension 80′ with a groove 82′, an interior 84′, pivotapertures 86′, a pivot pin 88′, a curved surface 89′(not shown), anouter surface 90′ (not shown), a stop 92′ (not shown), an abutmentsurface 93′, an inner planar surface 95′ and a planar surface 96′ thatare identical or substantially similar in shape and function to therespective hinge outer member 76, inner member 78, extension 80, groove82, interior 84, pivot apertures 86, pivot pin 88, curved surface 89,outer surface 90, stop 92, abutment surface 93, inner planar surface 95and planar surface 96 described herein with respect to the hinge 70.

It is noted that other hinge or pivot mechanisms may be utilized in lieuof the hinge assembly 16. For example, the polyaxial joint 95illustrated and described in Applicant's U.S. Pat. No. 7,152,261 andU.S. patent application Ser. No. 11/159,494 filed Jun. 23, 2005, may beincorporated into the patient support structure 10 at the break or jointbetween the sections 12 and 14. The disclosures of U.S. Pat. No.7,152,261 and U.S. patent application Ser. No. 11/159,494 areincorporated by reference herein. It is foreseen that a rotatinguniversal joint operated type of hinge mechanism could be used with theinvention, etc.

With particular reference to FIGS. 6 and 12, the cable drive system 18includes a rotary motor 98 cooperating with and driving by rotation apair of winch cylinders 99 disposed on either side of the motor 98. Themotor 98 and cylinders 99 are mounted to the end connector 58′ locatednear the support column 4. Each cable 20 is attached to one of the winchcylinders 99 at one end thereof and to the end connector 58 at the otherend thereof. In a first longitudinal position wherein the section 12 issubstantially planar with the section 14, the cables 20 are wound aboutthe winch cylinders 99 an amount to provide enough tension in the cables20 to maintain such a substantially planar orientation andconfiguration, with the hinge extensions 82 and 82′ being in contactwith each of the cables 20. The motor 98 is preferably low speed andhigh torque for safely winding both of the cables 20 simultaneouslyabout the cylinders 99 to draw the section 12 toward the section 14 toresult in an upward breaking or jointing configuration with the hinges70 and 72 disposed in spaced relation with the cables 20 and the hinges70 and 72. The motor 98 may be reversed, reversing the direction ofrotation of the winch cylinders 99 for slowly unwinding the cables 20 toa downward breaking or jointing configuration. As the cables 20 unwind,gravity draws the support sections 12 and 14 downward with the cables 20being received in the grooves 82 and 82′ of the hinge extensions 80 and80′. As the cables 20 slacken, the hinges 70 and 72 continue to lowerpressing down upon the cables 20.

It is noted that the frame sections 12 and 14 are typically equippedwith pads (not shown) or other patient holding structure, asillustrated, for example, in Applicant's U.S. Pat. No. 5,131,106, thedisclosure of which is incorporated by reference herein. It is foreseenthat such patient holding structure could translate or glide along theframe sections 12 and 14. Furthermore, with respect to FIGS. 13 and 14,the frame member sections 66 and 68 of section 12 and the frame membersections 66′ and 68′ of the section 14 may be replaced withsubstantially rectangular imaging tops or sections 100 and 101′respectively. Each of the sections 100 and 101′ having elongate slots101 formed therein to allow for attachment of the hinge mechanisms 70and 72 in a manner identical or substantially similar to what has beendescribed herein with respect to the frame sections 12 and 14.

With reference to FIGS. 15-17, the imaging sections 100 and 100′ areillustrated, replacing the frame sections 12 and 14 of the embodimentdisclosed in FIGS. 1-12. Each of FIGS. 15-17 represent configurations inwhich the cable drive 18 is tensioned such that the sections 100 and100′ are kept in a substantially coplanar configuration. FIG. 15illustrates a configuration in which the column 3 is telescoped upwardlywith the frame sections hinging at the support assemblies 5 and 6,resulting in an inclined position or configuration of the entire patientsupport. In the illustrated embodiment, the section 100 would preferablyreceive a patient's head. Therefore, FIG. 15 illustrates a reverseTrendelenburg position or orientation. FIG. 16 illustrates the sections100 and 100′ again in a substantially common plane with both sectionsbeing rotated to a tilted position produced by a powered rotation of thesub assemblies 26 and passive rotation of the assembly 26′ with bothcolumns 3 and 4 otherwise holding the sections 100 and 100′ at the sameheight. FIG. 17 illustrates both tilting due to rotation of theassemblies 26 and 26′ and also a sloping or inclined position with thecolumn 4 being extended vertically. Thus, FIG. 17 illustrates aTrendelenburg position or orientation with both the sections 100 and100′ remaining in substantially the same plane. It is foreseen that abearing block assembly at one or both ends of the table provides forsome lateral translation to prevent binding of the hinge mechanisms.

With reference to FIGS. 18-20, there is illustrated three upwardbreaking or hinging configurations of the structure 1. FIG. 18illustrates a symmetrical upward breaking configuration wherein thecolumns 3 and 4 are holding the respective support assemblies 5 and 6 atsubstantially the same height with the cables 20 being shortened byrotation of the winch motor to result in an upward break or joint in thehinge assembly 16. FIG. 19 illustrates the column 3 being extended to amaximum height and the cables reeled to shorten a distance between thesections 100 and 100′. An example of such an upward break or joint withreverse Trendelenburg would be a head or column 3 height of 43 inches, afoot or column 4 height of 24 inches and a 35 degree upward break withzero degree roll. FIG. 20 illustrates an upward breaking Trendelenburgwith the column 4 being extended to a maximum height.

With reference to FIGS. 21-23, there is illustrated three downwardbreaking configurations of the structure 1. FIG. 21 illustrates asymmetrical downward breaking configuration wherein the columns 3 and 4are holding the support assemblies 5 and 6 respectively, at the sameheight with the cables 20 being unwound or slackened to result in adownward break or joint in the hinge assembly 16, the hinges 70 and 72contacting the cables 20. FIG. 22 illustrates a downward breakingreverse Trendelenburg with the column 3 being extended to a maximumheight resulting in a patient's head end being at a maximum height. FIG.23 illustrates a downward breaking Trendelenburg with the column 4 beingextended to a maximum height.

It is noted that in each of the configurations illustrated in FIGS.18-23, the sub-assemblies 26 may be rotated in either direction,resulting in a tilted or rotated as well as upwardly or downwardlybroken or hinged configuration. For example, FIG. 24 illustrates thestructure 1 with support frame sections 12 and 14 positioned in aconfiguration similar to that illustrated in FIG. 19, but also includingrotation, resulting in a tilting and upwardly breaking or jointedconfiguration of the structure 1. An example of the position illustratedin FIG. 24 would be: a head or column 3 height of 41 inches, a foot orcolumn 4 height of 34 inches and a 35 degree upward break or joint with10 degree roll.

With reference to FIGS. 25-29, another structure, generally 102according to the invention is illustrated. The structure 102 utilizesall of the elements described herein with respect to the structure 1 andtherefore the same references numerals are used for the same elements orfeatures. The structure 102 differs from the structure 1 in that theH-bar posts 40 and 40′ are replaced or modified to be extended H-barposts 40A and 40A′, allowing for the mounting of two elongate structure10 and cooperating cable drives 18. In the embodiment shown in FIG. 25,one of the structures 10 includes the frame member 12 and 14 while theother structure is an imaging top having sections 100 and 100′. Aspreviously described herein, the cooperating H-bar posts 40A and 40A′equipped with a plurality of apertures allows for the placement of thesupport structures 10 at a variety of locations. For example, FIGS.25-28 illustrate a first spaced orientation of the elongate frame withrespect to the elongate imaging top with the imaging top located at a“lower” position identified by the reference letter L. The identicalcomponents are shown in FIG. 29 with the imaging top located at a“mid-position” identified by the reference letter M, illustrating a morecompact or closely spaced orientation of the elongate frame with respectto the elongate imaging top than what is shown in FIG. 25.

As illustrated in FIGS. 25-28, the structure 102 provides for thecomplete rotation and thus a roll-over of a patient by actuation of themotor of the rotation subassembly 26 using the controller 29. Thestructure 102 shown in FIGS. 25-29 is further illustrated with anon-telescoping base support 110 fixed to each of the columns 3 and 4and rollers or castors 112 at the base of the structure 102.

With reference to FIGS. 30 and 31, another embodiment or systemaccording to the invention, generally 200 is illustrated. The system 200broadly includes an elongate length-adjustable base 202 surmounted ateither end by respective first and second upright support piers orcolumns 203 and 204 which are connected to respective first and secondsupport assemblies, generally 205 and 206. Between them, the supportassemblies 205 and 206 uphold an elongated breaking, hingeable orpivotable patient support structure, generally 210. The hinge structureis described in detail in Applicants's U.S. Pat. No. 7,152,261 and alsoU.S. patent application Ser. No. 11/159,494, both disclosures of whichare incorporated by reference herein. The embodiment 200A illustrated inFIG. 31 differs from the structure 200 only in that thelength-adjustable base 202 is replaced by a first base 220 attached tothe pier 203 and a second base 222 attached to the pier 204. All of thebases 202, 220 and 222 include castors or rollers 230 or some othermovable structure to allow the piers 203 and 204 to move toward and awayfrom one another during upward or downward breaking of the structure210.

It is foreseen that cable drives as described herein, other types ofmotor drives including screw drives, universal joints, hydraulicsystems, and the like, may be utilized to facilitate both upward anddownward breaking of the support structure 210.

Another patient support structure according to the invention, generally301, is illustrated in FIGS. 32-34. The structure 301 generally includesa horizontally telescoping floor mounted base 302, a conventional orstandard telescoping and inclinable operating table support structure304, a telescoping end support or pier 306 and a hinged or pivotallyupwardly and downwardly breaking or jointing support structure 310connected to both the structure 304 and the pier 306. The patientsupport structure 310 further includes a first cantilevered section 312and a second section 314. The first section 312 is fixed to and extendsfrom the operating table support 304. The second section is attached tothe pier 306 by a hinge or pivoting assembly 320, such as the supportassembly 5 described herein with respect to the structure 1. The hingemechanism 316 disposed between the support sections 312 and 314 may be aconventional hinge, pivot, or pivot or hinge systems previouslydescribed herein.

In use, the operating table support 304 utilizes electric or other powermeans to move the support section 312 up and down and at an incline, asis known in the art. The operating table support 304 can also tilt orrotate from side to side. In response to the movement of the section312, the section 314 also moves, resulting in upward and downwardbreaking illustrated in FIGS. 32 and 33. In response to the movement ofthe section 312, the electric powered telescoping base 302 moves thepier 306 toward or away from the support 304. The pier 306 includes amotor for raising and lowering the pier at the connection 320.

As stated above with respect to other embodiments of the inventiondescribed herein, it is foreseen that cable drives as described herein,other types of drives including screw drives, hydraulic systems, and thelike, may be utilized to facilitate both upward and downward breaking ofthe support structure 310 at the joint 316.

With reference to FIGS. 35-47, another patient support structureaccording to the invention, generally 401 includes first and secondupright support piers or columns 403 and 404 that are connected to oneanother by a non-telescoping base support 402. In some embodimentsaccording to the invention, each column may be surmounted on anindependent movable or stationary base. The column 403 is connected to afirst support assembly, generally 405 and the column 404 is connected toa second support assembly, generally 406. Between them, the supportassemblies 405 and 406 uphold at least one removable elongate andarticulate, substantially centrally jointed or breaking patent holdingor support structure, generally 410. The assembly includes a first framesection 412, a second frame section 414 and a pair of identical hingeassemblies, generally 416, disposed between and connecting the first andsecond frame sections 412 and 414. In the illustrated embodiment, thefirst frame section 412 for holding a head and upper body of a patientis of a slightly shorter longitudinal length (along an axis X) than thesecond frame section 414. Therefore, the spaced hinge assemblies 416 areapproximately centrally located relative to a body of a patient beingplaced on the structure 410. In the illustrated embodiment, the hingeassembly further includes a drive system that includes a pull rodassembly, generally 418, and cooperating spaced slider bars 420. Again,other drive systems are foreseen.

The columns 403 and 404 are substantially similar in form and functionto the columns 3 and 4 previously described herein with respect to thestructure 1. The columns 403 and 404 are supported by outwardlyextending feet 422 that include casters that may be equipped with afloor-lock foot lever for lowering the feet 422 into a floor-engagingposition. The columns 403 and 404 each include two or more telescopinglift arm segments respectively that permit the height of each of thecolumns 403 and 404 to be selectively increased and decreased in orderto raise and lower all or a selected portion of the connected patientsupport structure 410.

Each of the support assemblies 405 and 406 generally includes a rotationsubassembly 426 and 426′ and an angulation subassembly 427 and 427′,respectively, that are the same or substantially similar to thesubassemblies 26, 26′, 27 and 27′ previously described herein withrespect to the structure 1. In the illustrated embodiment, theangulation subassembly 427 connected to the frame 412 for holding thehead and upper body of a patient is shown as substantially identical tothe subassembly 27 and therefore shall not be described further herein.The subassembly 427′ is substantially similar to the subassembly 27′,but with some modifications, including a frame 436 disposed transverseto the overall longitudinal axis X of the structure 401, the frame 436providing for slidable support of the pair of identical slider bars 420that are disposed at either side of the frame 414 and near thesubassembly 427′.

Similar to the rotation subassembly 26 previously described herein, therotation subassembly or mechanism 426, includes at least one motorhousing 430 surmounting the support column 403. It is foreseen that acooperating motor may also be mounted on the support column 404. A mainrotational shaft 432 extends from the motor housing 430 that turns arotation structure or bar that in turn is connected to and rotates thepatient support 410 about a longitudinal axis. In particular, the motorhousing 430 contains a rotary electric motor or other actuator drivinglyengaged with the shaft 432. The rotation mechanism 426 is operated byactuating the motor using a switch or other similar means. The shaft 432rotationally cooperates with a pair of substantially vertically disposedtranslation posts or H-bar posts 440, the posts 440 being attached toand disposed at either end of the transverse rotation structure or bar433. Each H-bar post 440 includes a plurality of apertures 444, allowingfor selective, hinged vertical placement of the frame section 412identical or substantially similar to what has been described previouslyherein with respect to the H-bar posts 40, the angulation sub-assembly27 and the frame end section 58 of the frame section 12 previouslydescribed herein with respect to the structure 1.

With particular reference to FIGS. 38-40, as stated above, thesub-assembly 426′ is substantially similar to the sub-assembly 426 andtherefore may include a motor and further includes either an active orpassive rotational shaft 432′ that engages a rotation structure or bar433′ that is attached to a pair of substantially vertically disposedH-bar posts 440′. A plurality of cooperating apertures 444′ formed inthe posts 440′ provide passageway for a pivot pin 446 to extendtherethrough. The pivot pin 446 is receivable in each cooperating pairof apertures 444′, allowing for selective placement of a translationconnector 448 that is sized and shaped to be received between the pairof posts 440′ and also receive the pivot pin 446 therethrough. The pin446 and connector 448 are thus positionable in an orientation transverseto the longitudinal axis X of the patient support frame 410 at a varietyof heights to be selected by the surgeon and readily changeable, evenduring surgery if necessary, to vary the height of the frame section414. The multiple location or height feature is also advantageous whenmore than one frame or patent structure is mounted in tandem, forexample, when both a frame and imaging table are used together, such asis shown in the embodiment illustrated in FIGS. 25-29. The position ofthe frame or other structure may be desirably changed to provide closeproximity to an imaging top with a distance between a patient supportand an imaging top being expandable or reduceable depending upon thesize or other attributes of a patient and surgical or otherrequirements. The connector 448 has a slot for receiving the pivot pin446. It is noted that the H-bar support 440′, apertures 444′, elongatetransverse pin 446 and translation connector 448 are the same orsubstantially similar in form and function with the respective support40, apertures 44, transverse pin 46 and translation connector 48previously described herein with respect to the structure 1.

The translation connector 448 is in turn attached to a pivot connector452 that is substantially similar to the pivot connector 52 previouslydescribed herein with the exception that rather than being attacheddirectly to an end piece or section of the patient support frame 414,the pivot connector 452 is fixed to the frame 436 that is fixed to andsupports the slider bars 420 near end surfaces 464 thereof. Thus, theslider bars 420 are in a hinged relationship with the H-bar supports440′. The slider bars 420 are also in slidable attachment with the framesection 414 and disposed substantially parallel to a longitudinal axisof the section 414 as will be described in greater detail below. Suchslidable attachment facilitates upward and downward breaking or hingingof the section 414 with respect to the section 412 at the hingemechanism 416. Also as more fully described below, the pull rod assembly418, that is connected to both the frame section 414 and the hingemechanism 416, is extendable and retractable, controlling the hinge orbreak angle of the patient support 410 and rendering the support 410rigid at a desired upward or downward break or joint of the hingemechanism 416.

With particular reference to FIGS. 38 and 39, the support frame section414 includes opposed elongate and parallel frame sections 466 and 468attached to one another by a transverse end frame section 469. A supportplate 470 is attached to and is disposed below each of the sections 466,468 and 469 to provide additional support and stability to the framesection 414 at and near the end section 469. Further support is providedby a pair of frame support plates 471, both of which are fixed to theend support frame section 469 near one end thereof; one plate 471 beingfixed to the section 466 and the other plate 471 being fixed to thesection 468. At least one pair of slider bar holding structures 472 arefixed to the support plate 470 and extend downwardly therefrom at eachof the frame sections 466 and 468. Each structure 472 includes a throughbore that extends parallel to the frame sections 466 and 468, thestructure 472 for slidably receiving one of the slider bars 420 directlybelow one of the frame sections 466 and 468 and also orienting the pairof slider bars 420 in a direction substantially parallel to the framesections 466 and 468. The illustrated slider bar holding structures 472are spaced from the end frame section 469 and located near a forwardedge 473 of the plate 470. In the illustrated embodiment, the holdingstructures 472 are also bolted to the frame sections 466 or 468. A pairof pull-rod supports 475 are also fixed to the support plate 470 and theframe 414 and extend downwardly therefrom at each of the frame sections466 and 468 and also downwardly from the end frame section 469. Eachstructure 475 includes a through bore for receiving a transverse pivotpin or bar 476 mounted below the slider bars 420. The pull-rod assembly418 is attached to the support 475 at the pivot pin 476 and is thus inhinged relationship with the support 475, pivotally attached thereto atend portions 478.

The pull-rod assembly 418 further includes a pair of housings 480, eachhousing attached to an end portion 478 and having a powered actuator 482cooperating with one of a pair of rotatable extendible and retractablerods 484 and a pair of hinge connectors 486, each pivotally attached toa respective cam plate 488 of the respective hinge mechanism 416 at arespective pivot pin 490. The cam plate 488 has a substantiallycentrally located curvilinear wall 489 forming a curvate aperture orslot, a lower circular aperture for receiving the pin 490 and an uppercircular aperture for receiving a pin 502, described in greater detailbelow. Each pull rod 484 is rotatably mounted within one of the housings480, such rotation being controlled by operation of the actuator 482located in the housing 480 and engaged with the rod 484 to screw andthus selectively move or draw the rod 484 into or away from the hingemechanism 416 in a direction along a longitudinal axis of the rod 484,that in turn results in breaking or jointing of the patient support 410at the hinge mechanism 416. It is foreseen that other embodimentsaccording to the invention may utilize other types of push/pull rods ormechanisms, including, for example hydraulic systems. An additionalcentrally located pull-rod or piston may be included to provideadditional support. Furthermore, other hinge mechanisms according to theinvention may be utilized in lieu of the mechanism 416, for exampleincluding, but not limited to, polyaxial joints, roller with spokes,sprockets, toothed gears, universal axis gears, or the like.

With particular reference to FIG. 41, the illustrated pair of hingemechanisms 416, each having a cam plate 488, further include a pair offorked arms 492 extending from the frame section 412 and a pair ofcooperating forked arms 494 attached to and extending from the section414. Hinge arms 496, 497, 498 and 499 having apertures near oppositeends thereof for receiving pivot pins cooperate with the respective camplate 488 and adjacent forked arms 492 and 494 at pivot pins 501, 502,503 and 504. All of the pivot pins 490, 501, 502, 503 and 504 aredisposed transverse to the longitudinal axis X of the patient supportstructure 401. In particular, the pivot pin 501 is received by circularapertures located near first ends of the hinge arms 496 and 498 and acircular aperture in the arm 492, thus pivotally attaching the arm 492with both the hinge arms 496 and 498. The pivot pin 502 is received byan upper circular aperture in the cam plate 488 and circular apertureslocated near the ends of each of the forked arms 492 and 494, thuspivotally attaching the cam plate 488 with both of the forked arms 492and 494. The pivot pin 503 is received by circular apertures locatednear first ends of the hinge arms 497 and 499 and a circular aperture inthe arm 494, thus pivotally attaching the arm 494 with both the hingearms 497 and 499. The pivot pin 504 is received by the slot 489 and alsoby circular apertures located near second ends of the hinge arms 496,497, 498 and 499, thus pivotally attaching all four hinge arms 496, 497,498 and 499 with the cam plate 488 at the slot 489.

Also, with particular reference to FIGS. 35 and 38-41, the structure 401is shown in a neutral, planar orientation, with the pull-rod assembly418 holding the hinge mechanism 416 in such neutral position, with theforked arms 492 and 494 in parallel. In such position, the pin 504 islocated at or near a rear-ward end of the slot 489.

With reference to FIGS. 42-44, as the rod 484 is rotated to selectivelylengthen the rod 484, the pin 504 remains near the rear-ward end of theslot 489 and the pushing of the rod toward the hinge mechanism 416pivots the cam plate 488 at the pivot pin 490, causing the arms 492 and494 to move toward the rod hinge connector 486 and thus pivot thepatient support at the pin 502, causing a downward break or joint in thepatient support 410. With reference to FIGS. 45-47, as the rod 484 isrotated to selectively shorten the length thereof, the support portion414 slides along the slider bars 420 away from the end support 404. Atthe same time, the pin 504 slides along the slot 489 to an opposite orforward end thereof as the cam plate pivots in a forward direction aboutthe pin 490. The movement of the rod 484 thus causes an upward break atthe pivot pin 502. In the illustrated embodiment, the patient frame ispinned at the head end, but is free to move along the fixed slider bar420 at the foot end, providing dynamic support to the patient frame. Theslider bar mechanism can be attached to a bearing block mechanism toprovide lateral translation movement, as described previously.

It is noted that since the patient frame is free to move over the sliderbar, a horizontal force component is generated by the combinedcomponents of the patient support. When the support is broken or jointedupward, the angle of the foot end frame imparts a horizontal force onthe slider that urges the end supports 403 and 404 toward one another.When the table is broken downward, a horizontal force develops thattends to push the end supports apart. It has been found that themagnitude of the horizontal force is a function of support loading andbreak angle, and thus, for example, if a working limit of five hundredpounds is selected for the patient support, a worst case of horizontalloading is only about fifty-eight pounds at an upward break or joint ofthirty-five degrees. It is noted that the illustrated structure 401advantageously supports a breaking or jointing range from aboutthirty-five degrees up to about twenty degrees down. Throughout suchrange, the horizontal forces imposed by the structure are minimized bythe illustrated locked support frame that moves on a slider bar at thefoot end of the support.

As with the structure 1 configurations illustrated in FIGS. 18-23, theupward and downward breaking of the patient support 410 may be modifiedby placing the portions 412 and 414 at different vertical locationsalong the H-bar supports 440 and 440′, thus resulting in symmetrical orasymmetrical breaking configurations. Furthermore, the portions 412 and414 may be rotated or tilted as described above with respect to thestructure 1.

It is to be understood that while certain forms of the present inventionhave been illustrated and described herein, it is not to be limited tothe specific forms or arrangement of parts described and shown.

What is claimed and desired to be secured by Letters Patent is asfollows:
 1. An apparatus for supporting and positioning a patient duringa surgical procedure, the apparatus comprising: a) first and second endsupports; b) an elongate patient support structure extending between andsupported by the first and second end supports and having opposite endsconnected to the first and second end supports; c) the patient supportstructure including a frame section that has spaced opposite sides, soas to provide an open space therebetween that is free of obstructionscentrally and that allows a patient's belly to extend downward betweenthe opposite sides when the patient is in a prone position on thepatient support structure; wherein d) the frame section has a firstframe portion and a second frame portion, the first frame portion joinedwith the second frame portion at a joint; e) the joint has a pair ofspaced hinge mechanisms joining the frame portions; and f) the hingemechanism being operably articulatable to move the frame portionsbetween a plurality of angular orientations with respect to each oneanother.
 2. An apparatus for supporting and positioning a patient duringa surgical procedure, the apparatus comprising: a) first and second endsupports; b) an elongate patient support structure extending between thefirst and second end supports and being connected to and supported bythe first and second end supports; c) the patient support structureincluding a frame section that has spaced opposite sides, that providean open space therebetween that is free of obstructions centrally andallows a patient's belly to extend downward between the opposite sideswhen the patient is in a prone position on the apparatus; wherein d) theframe section includes a first frame portion and a second frame portionand a pair of spaced apart hinges joining the first and second frameportions; wherein e) the hinges are moveable such that the frameportions are configured into a plurality of angular orientations withrespect to each other.
 3. An apparatus for supporting a patient during amedical procedure, the apparatus comprising: a) a base structureincluding first and second opposed end supports, each end support beingattached to the base structure; b) an elongate patient support structureincluding first and second portions joined inwardly at a pair of spacedapart hinges, the patient support structure having opposite endsconnected to the end supports by connection assemblies, and the patientsupport structure being alignable in a first plane and movable to aplurality of angular orientations with respect to one another on eitherside of the first plane; and c) at least one of the connectionassemblies having a motorized mechanism to angulate the patient supportstructure at the pair of hinges; wherein d) the connection assemblymotorized mechanism is operably translated longitudinally toward thehinges when the patient support structure is moved into the plurality ofangular orientations.
 4. A patient support apparatus, including: a) anelongate patient support; b) a pair of end supports that are selectivelyvertically adjustable so as to raise and lower; c) the end supportsbeing connected to opposite respective ends of the patient support; d) afirst secondary elevator post located between a respective end of thepatient support and a respective end support; the elevator postproviding for additional vertical adjustment of the respective end ofthe patient support; and e) a second secondary elevator post locatedopposite the first secondary elevator post between a respective end ofthe patient support and a respective end support.
 5. A patient supportapparatus according to claim 4, wherein: a) each secondary elevator postis infinitely adjustable over a vertical range of movement.
 6. Anapparatus for supporting a patient above a floor during a medicalprocedure, comprising: a) first and second support columns that areindependently adjustable with respect to a vertical height from thefloor; b) an elongate base intercoupling the columns; c) a patientsupport structure including a first frame section and a second framesection hingedly connected together by a hinge assembly, the first framesection including a first end and the second frame section including asecond end, each of the first and second ends being rotatably coupledwith a respective one of said columns; d) the patient support structureextending between said columns and constructed so as to provideangulation of the first end with respect to the second end; and e) athird independently adjustable vertical height adjustment cooperatingwith each of the first column and the second column so as to be able tofurther lower or raise a respective end with respect to the floor. 7.The apparatus as set forth in claim 6, wherein: a) the third verticalheight adjustment is located between said first and second supportcolumns.
 8. The apparatus of claim 6, wherein the hinge assemblycomprises a pair of hinges.
 9. The apparatus of claim 7, wherein thethird independently adjustable vertical height adjustment for each ofthe first column and the second columns comprises a pair of H-bar postsconfigured to receive a pivot pin to operably couple the base structureand the elongate patient support structure together.
 10. An apparatusfor supporting a patient above a floor during a medical procedure, theapparatus comprising: a) a base structure including first and secondspaced opposed end supports; each end support having independentvertical height adjustment with respect to the floor; b) an elongatepatient support structure including head end and foot end portionsjoined at an articulation therebetween so as to form an open frame onone end, the patient support structure having opposite ends connected tothe end supports respectively by connection subassemblies, the patientsupport structure opposite ends being alignable in a plurality ofangular orientations with respect to the base end supports; c) thearticulation having a pair of spaced apart hinges joining the patientsupport structure head and foot end portions, and being movable betweena plurality of orientations associated with the angular orientations ofthe ends of the patient support structure relative to the end supports;and d) a motorized structure to rotatably pivot the articulation, suchthat the articulation breaks at the pair of spaced apart hinges, themotorized structure being located on one end of the base structure andconfigured as a lifting and positioning mechanism, and wherein e) thepatient support structure end portion connection subassemblies include avertical axis and a traverse axis for angulation that translate withrespect to each other.
 11. The apparatus as set forth in claim 10,wherein: a) the patient support structure further includes a secondarticulation and a third articulation, each articulation being locatedbetween the patient support structure end and a respective end support.12. An apparatus for supporting a patient above a floor during a medicalprocedure, the apparatus comprising: a) a base structure including anupper portion and a lower portion, the upper portion tiltable from sideto side with respect to the lower portion; and b) an elongate patientsupport structure connected at one end thereof to the upper portion, thepatient support structure consisting of a first frame section and asecond frame section suspended above the floor and tiltable from side toside by the upper portion, the first frame section and the second framesection hingedly connected together by only a single hinge assembly, theupper portion configured to angulate the patient support structure intoinclined and declined orientations with respect to the floor.
 13. Theapparatus of claim 12, wherein the hinge assembly comprises a pair ofhinges.